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State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
The differential diagnosis of abnormal head shapes: separating craniosynostosis from positional deformities and
M H Huang1, W E Mouradian, S R Cohen
1Department of Plastic Surgery, Singapore General Hospital, Singapore. gplhhs@sgh.gov.sg
Insights
Accurate diagnosis of abnormal infant head shape is crucial. Differentiating craniosynostosis from non-synostotic causes ensures appropriate management, guiding surgical versus non-surgical treatment for conditions like metopic synostosis and plagiocephaly.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Developmental Pediatrics
Background:
- Abnormal head shape in infants and children is common.
- Distinguishing craniosynostosis (requiring surgery) from non-synostotic deformities is diagnostically challenging.
- Accurate diagnosis is vital for appropriate patient management.
Purpose of the Study:
- To clarify the differential diagnosis of common abnormal head shapes in pediatric patients.
- To differentiate between craniosynostosis and non-synostotic causes of head deformity.
- To provide guidance on the management of specific conditions including metopic synostosis, positional dolichocephaly, and plagiocephaly.
Main Methods:
- Review of clinical and imaging features of three key diagnostic groups: metopic synostosis, prematurity-related dolichocephaly vs. sagittal synostosis, and plagiocephaly.
- Emphasis on posterior plagiocephaly, addressing overdiagnosis of lambdoid synostosis.
- Clinical monitoring protocols for craniosynostosis.
Main Results:
- Metopic synostosis exhibits a spectrum of severity; surgical correction is reserved for severe forms, but all require monitoring.
- Dolichocephaly in preterm infants is non-synostotic and managed conservatively.
- Scaphocephaly from sagittal synostosis necessitates surgical intervention.
- Posterior plagiocephaly is predominantly positional (non-surgical), with true lambdoid synostosis being rare.
Conclusions:
- Correctly diagnosing abnormal head shape is essential for guiding treatment decisions in pediatric patients.
- Positional molding is the most common cause of posterior plagiocephaly, requiring non-surgical management.
- All children diagnosed with craniosynostosis require ongoing monitoring for potential complications like increased intracranial pressure and developmental issues.
Abstract:
The correct differential diagnosis of an abnormal head shape in an infant or a child is vital to the management of this common condition. Establishing the presence of craniosynostosis, which warrants surgical correction, versus non-synostotic causes of head deformity, which do not, is not always straightforward. This paper deals with three groups of abnormal head shape that may cause diagnostic confusion: the spectrum of metopic synostosis; the dolichocephaly of prematurity versus sagittal synostosis; and the differential diagnosis of plagiocephaly. Special emphasis has been placed on the problem of posterior plagiocephaly, in the light of recent evidence demonstrating that lambdoid synostosis has been overdiagnosed. Metopic synostosis presents as a wide spectrum of severity. Although only severe forms of the disorder are corrected surgically, all cases should be monitored for evidence of developmental problems. The dolichocephalic head shape of preterm infants is non-synostotic in origin and is managed nonsurgically. The scaphocephalic head shape resulting from sagittal synostosis requires surgical intervention for correction. Posterior plagiocephaly may be due to unilambdoid synostosis or positional molding, which have very different clinical and imaging features. True lambdoid synostosis is rare. Most cases of posterior plagiocephaly are due to positional molding, which can usually be managed nonsurgically. Regardless of the suture(s) involved, all children with confirmed craniosynostosis should be monitored for increased intracranial pressure and developmental problems.
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